Mammograms are X-ray pictures of the breast that are effective for detecting breast cancer. A mammogram allows the doctor to have a closer look at changes in breast tissue that cannot be felt during a breast exam.
What can a mammogram tell my doctor?
During a screening or diagnostic mammogram, radiologists will look at X-rays for breast changes that look abnormal and for differences in each breast. They will compare past mammograms. The doctor will also look for lumps and calcifications.
- Lump or mass. The size, shape, and edges of a lump sometimes can give doctors information about whether or not it may be cancer. On a mammogram, a growth that is benign often looks smooth and round with a clear, defined edge. Breast cancer often has a jagged outline and an irregular shape.
- Calcification. A calcification is a deposit of the mineral calcium in the breast tissue. Calcifications appear as small white spots on a mammogram.
If calcifications are grouped together in a certain way, it may be a sign of cancer. Depending on how many calcium specks you have, how big they are, and what they look like, your doctor may suggest that you have other tests.
What about things I hear in the national news about screening guidelines?
Not all professional groups have the same opinion. Recently, the American Cancer Society (ACS) made some changes to their recommendations. They maintain that women aged 40-44 should have the option of a screening mammogram every year and endorse that women aged 45-54 should receive a yearly mammogram. According to the ACS, women 55 and older should get a mammogram every two years but still have the option of annual mammography if that is the choice of the patient and her physician. The U.S. Preventive Services Task Force has also made similar screening recommendations.
However, major professional groups including the National Comprehensive Cancer Network, the American College of Radiology and patient advocacy groups like Susan G. Komen still support annual screening mammography beginning at age 40
When should I start getting mammograms?
Mammography beginning at age 40 offers the best chance of detecting an early breast cancer. However, you should discuss your individual risk with your physician to decide what timing is right for you.
Mammography is the only test shown to decrease the number of deaths from breast cancer. Breast cancer is the second leading cause of cancer death in women and the personal choices of screening mammography should be discussed with a trusted Sentara physician.
I’m healthy and no one in my family has breast cancer. Do I still need to be screened?
Among all breast cancers, 1 in 6 is diagnosed in women in their 40s and 75% of all breast cancers arise in women with no significant family history. Screening mammography offers the greatest chance at detecting these cancers at an earlier stage. This means a quicker recovery and better quality of life.
Mammograms can identify dense breast tissue. What does that mean?
Following your mammogram, the breast center may notify you that you have dense breasts. Breast tissue is made of fatty and connective tissue. Dense breasts have less fat and more connective tissue. When a woman has dense breasts, small cancers are harder to find on a mammogram.
If you have dense breasts:
- Schedule a mammogram every year.
- Know your family history of breast cancer.
- Do monthly breast exams.
- Follow recommendations for having a clinical breast exam every three years from age 20 to 40 and yearly after age 40.
- Confirm your mammogram is done using digital mammography, which is the case at Sentara. Data suggests digital mammography is more effective for women with dense breasts.
- Discuss lifestyle changes with your physician to decrease your risk for developing breast cancer.
How long do I continue to get a mammogram?
Every patient is different, each with her own health profile and medical conditions. The chances of getting breast cancer increases with age, so as long as a woman is in good health, she should continue to have mammograms.
How do I prepare for my exam?
Try to avoid scheduling your mammogram for the week prior to your period if your breasts are tender or swollen to reduce discomfort. The best time for a mammogram is one week after your period. Always inform your doctor or X-ray technologist if there is any possibility that you are pregnant.
The American Cancer Society also recommends you:
- Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots.
- Describe any breast symptoms or problems to the technologist performing the exam.
- If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam.
What if I have breast implants?
If you have breast implants, be sure to tell us when you schedule your exam. The technician and radiologist must be experienced in X-raying patients with breast implants. Implants can hide some breast tissue, making it harder for the radiologist to see a problem when looking at your mammogram. To see as much breast tissue as possible, the X-ray technician will gently lift the breast tissue slightly away from the implant and take extra pictures of the breasts.
How is the test performed?
During your mammography appointment, a specially qualified radiologic tech will position your breast in the mammography unit. Your breast will be placed on a special platform and compressed with a paddle (often made of clear Plexiglas or other plastic). The tech will gradually compress your breast.
Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
Breast compression during a mammogram is necessary to:
- Even out the breast thickness so that all of the tissue can be visualized.
- Spread out the tissue so small abnormalities are less likely to be obscured by overlying breast tissue.
- Allow the use of a lower X-ray dose since a thinner amount of breast tissue is being imaged.
- Hold the breast still in order to minimize blurring of the image caused by motion.
- Reduce X-ray scatter to increase sharpness of picture.
You will be asked to change positions between images. The routine views are a top-to-bottom view and an angled side view. The process will be repeated for the other breast.
You must hold very still and may be asked to keep from breathing for a few seconds while the X-ray picture is taken to reduce the possibility of a blurred image.
The mammogram screening process should take about 30 minutes.
Can I afford a mammogram?
Yes. As part of the Affordable Care Act, health plans include coverage for annual screening mammograms without copay or deductible for women 40 and older. If you do not have any type of health coverage, please contact the financial counselor at one of our Comprehensive Breast Centers.
Can a mammogram be harmful?
A mammogram is a type of x-ray so there is a small amount of radiation. There is no data that shows that the radiation from screening mammograms can cause breast cancer. If the doctor notices an area on your mammogram you may have to return for additional x-ray images or an ultrasound. Having an abnormal mammogram does cause anxiety in patients. Sentara has listened to these concerns and developed a strategy committed to getting answers to our patients as soon as possible by shortening the time between the screening mammogram, additional imaging, and biopsy (if needed). For most patients, these additional images are normal and no further workup is required. A small number of patients will need a biopsy – most of which rule out cancer.
How will I find out the results?
While at your mammogram, ask when your results will be available. Do not assume the results are normal if you do not hear from your doctor or the mammogram facility.
A radiologist will analyze the images and send a signed report to your primary care or referring physician, who will discuss the results with you.
If your mammogram results were normal, your breast tissue will not show signs of a mass or calcification. Visit your health care provider if you notice a breast change before your next appointment.
If your mammogram results were abnormal, a breast change was found. It may be benign (not cancer), premalignant (may become cancer), or cancer. Keep in mind that most breast changes are not cancer. But all changes need to be checked, and more tests may be needed, such as a diagnostic screening.